Provider Demographics
NPI:1780450379
Name:ODONTOLOGIA GENERAL & ESTETICA LLC
Entity type:Organization
Organization Name:ODONTOLOGIA GENERAL & ESTETICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:LAZARO
Authorized Official - Last Name:SANTA MARIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-782-8487
Mailing Address - Street 1:101 AVE SAN PATRICIO
Mailing Address - Street 2:SUITE 930
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-2686
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 AVE SAN PATRICIO
Practice Address - Street 2:SUITE 930
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-2686
Practice Address - Country:US
Practice Address - Phone:787-782-8487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty